Intracranial meningioma with intratumoral hemorrhage

Meningiomas associated with intracranial hemorrhage are rare. Clinical presentation is frequently sudden. We present two patients with intracranial meningioma and intratumoral hemorrhage. One patient suffered concomitant intracerebral hemorrhage, which resulted in a decreased level of consciousness and hemiparesis. There was no evidence of coagulopathy in either patient. The patients underwent surgery for evacuation of the hematoma and tumor excision resulting in good recovery of neurologic function. The pathology reports revealed meningiomas; one was a syncytial type and the other was angioblastic. We reviewed 22 cases of meningioma associated with intratumoral hemorrhage, including our own, and found that death occurred in 55% (12/22) of patients with hemorrhagic complications. In the computed tomography (CT) era, there were 13 patients; of these, seven (58%) had recovered, and five (38%) died. There were nine cases from the pre-CT era; of these, seven (78%) died, and none had a good recovery. Early diagnosis with definitive surgery can bring about a more favorable outcome.